MEDICARE: DR. THOMAS JOHN CUMBO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	103661	NY
2	207RI0200X	Infectious Disease Physician	103661	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396737532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOHN CUMBO MD

Provider Business Mailing Address
First Line	:	354 LINCOLN PKWY
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-3121
Country	:	US
Telephone Number	:	716-873-8311
Fax Number	:	716-447-9152

Provider Business Practice Location Address
First Line	:	354 LINCOLN PKWY
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-3121
Country	:	US
Telephone Number	:	716-873-8311
Fax Number	:	716-447-9152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	01/31/2012

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